Individual
AMANDA R GODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3808 S GREYSTONE CT, SPRINGFIELD, MO 65804-6561
(417) 889-3332
(417) 881-1410
Mailing address
3808 S GREYSTONE CT, SPRINGFIELD, MO 65804-6561
(417) 889-3332
(417) 881-1410
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2009018151
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431560263
TRICARE
MO
01
—
8P159
ARKANSAS BLUECROSS/BLUE SHIELD
MO
01
—
P00985991
RR MCR
MO
Enumeration date
07/09/2009
Last updated
03/18/2016
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